The purpose of this survey is to collect some of your observations about homelessness.
The United Muslim Movement Against Homelessness
(U.M.M.A.H.) and the Muslims Women's Help
Network (MWHN) are presently developing strategies aimed at serving the
needs of the homeless, displaced, or those threatened with homelessness within the Islamic
community.

To assist the need assessment for these efforts, we are requesting that Muslims and
others with sincere interest in the plight of homelessness complete this brief survey. It
should only take a few minutes of your time. Your honest sharing and input will be of
benefit to the development of an improved support/delivery system, insha'Allah.

Please fill out the information as requested. Then at the end of the form supply your
name and contact information should you so choose (optional), and submit the form. Thank
you!

Please select only one answer.

Do you presently know any Muslim who is currently homeless?

Yes
No
Don't know

2. Do you know any Muslim who was homeless for any
period of time within the past year?

Yes No
Don't know

3. If you were aware of someone who was/is
homeless, the circumstances were those of

a male a female a
family a
single-headed (female) family

4. Do you think that Muslims should help other
Muslims who are homeless?

Yes No
Don't know

5. Do you think that non-Muslims should help
Muslims who are homeless?

Yes No
Don't know

6. Do you think that Muslims should help
non-Muslims who are homeless?

Yes No
Don't know

7. Would you take an active role in helping the
homeless?

Yes No
Don't know

It would be helpful to know just a couple of things about you.
Please answer the following:

1. What is your age?

under 1919-3031-4546+

2. What is your
gender?

MaleFemale

Please enter any additional comments regarding this survey or your awareness of the
impact of homelessness (optional):

If you would like us to send you some
literature about homelessness, please indicate your
mailing address?